Bottom Line:
By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon.In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality.Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

Affiliation: Research Centre of the University of Montreal Hospital (CR-CHUM), Montreal, Quebec, Canada; School of Public Health, University of Montreal, Montreal, Canada.

ABSTRACTTo assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

pone.0120922.g002: Proportion of antenatal care (ANC), facility based delivery (FBD) and modern contraceptive use (MC) in selected countries.

Mentions:
The utilization of ANC increased in the three countries with sufficient progress towards their MDG 5 target (Fig. 2). The difference in the proportions of ANC use between the first and third surveys suggested 8.7, 9.3 and 5.7 percent increases in Ethiopia, Madagascar and Uganda, respectively (Table 2). With the exception of Uganda, where the proportion of ANC use increased from 39.2 to 46.6 percent over time in rural areas only, the utilization of ANC increased in both rural and urban regions in countries with satisfactory progress towards their MDG 5 goals. The utilization of FBD increased over time in both rural and urban areas in Ethiopia as well as in Uganda. The utilization of FBD did not change over time in Madagascar. Results also indicated that modern contraceptive use increased by 14, 15.7 and 4.2 percent over time in Ethiopia, Madagascar and Uganda, respectively. Among countries with insufficient progress towards their MDG 5 targets, only Cameroon showed increased utilization of maternal and reproductive health care. Although the uptake of modern contraceptive methods increased by 13.3 and 4.9 percent in Zambia and Zimbabwe over time, the utilization of ANC declined in these countries. Furthermore, in Zimbabwe, the utilization of FBD declined from 75 percent in 1999 to 65 percent in 2010/11.

pone.0120922.g002: Proportion of antenatal care (ANC), facility based delivery (FBD) and modern contraceptive use (MC) in selected countries.

Mentions:
The utilization of ANC increased in the three countries with sufficient progress towards their MDG 5 target (Fig. 2). The difference in the proportions of ANC use between the first and third surveys suggested 8.7, 9.3 and 5.7 percent increases in Ethiopia, Madagascar and Uganda, respectively (Table 2). With the exception of Uganda, where the proportion of ANC use increased from 39.2 to 46.6 percent over time in rural areas only, the utilization of ANC increased in both rural and urban regions in countries with satisfactory progress towards their MDG 5 goals. The utilization of FBD increased over time in both rural and urban areas in Ethiopia as well as in Uganda. The utilization of FBD did not change over time in Madagascar. Results also indicated that modern contraceptive use increased by 14, 15.7 and 4.2 percent over time in Ethiopia, Madagascar and Uganda, respectively. Among countries with insufficient progress towards their MDG 5 targets, only Cameroon showed increased utilization of maternal and reproductive health care. Although the uptake of modern contraceptive methods increased by 13.3 and 4.9 percent in Zambia and Zimbabwe over time, the utilization of ANC declined in these countries. Furthermore, in Zimbabwe, the utilization of FBD declined from 75 percent in 1999 to 65 percent in 2010/11.

Bottom Line:
By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon.In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality.Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.

Affiliation:
Research Centre of the University of Montreal Hospital (CR-CHUM), Montreal, Quebec, Canada; School of Public Health, University of Montreal, Montreal, Canada.

ABSTRACTTo assess social inequalities in the use of antenatal care (ANC), facility based delivery (FBD), and modern contraception (MC) in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda) had <350 MMR in 2010 with >4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe) had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS) before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda), ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries which made progress towards reducing maternal mortality.